title: High cholesterol levels are associated with improved long-term survival after acute ischemic stroke.
abstract: BACKGROUND
  Prior statin treatment and high admission cholesterol have been associated with favorable outcome after ischemic stroke (IS), a paradox not completely explained. The aim of this study was to investigate the effect of admission cholesterol levels and the impact of statin treatment on short- and long-term survival after IS.
  
  
  METHODS
  Consecutive patients admitted in 2006 and 2010 were included in the study. Total cholesterol of 4.6 mmol/L or more was defined as high. Logistic regression analysis was performed to assess predictors of 1-month mortality, and Cox proportional hazard regression analysis was applied to investigate predictors of long-term mortality.
  
  
  RESULTS
  Of 190 patients included in the final analysis, 21 (11%) died within 1 month and 61 (32%) died during 7 years of observation. Low cholesterol was associated with older age, lower blood pressure (BP), presence of angina, and higher risk of death. Three-month, 1-year, and 5-year survival rates were 100%, 98%, and 84%, respectively, in high cholesterol patients, compared with 92%, 87%, and 57% in low cholesterol group (P = .0001 with the log-rank test). Mortality risk was increased for patients with low cholesterol (hazard ratio: 1.97; 95% confidence interval [CI]: 1.05-3.69), after adjustment for age and admission National Institutes of Health Stroke Scale score. After further adjustment for angina and admission BP, the effect of cholesterol on mortality risk was still obvious, yet attenuated (hazard ratio: 1.87; 95% CI: .94-3.32).
  
  
  CONCLUSIONS
  High admission cholesterol may be associated with increased long-term survival after IS. Future studies on the temporal profile of cholesterol levels and stroke outcome would be of interest.
authors.affiliation: Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. Electronic address: ioanna.markaki@ki.se.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Markaki
authors.affiliation: Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Nilsson
authors.affiliation: Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kostulas
authors.affiliation: Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Sjöstrand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000097:blood* / Q000401:mortality*; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000401:mortality*; D013534:Survival
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: Brain ischemia; cholesterol; fatal outcome; statins; stroke